Liver enzymes

December 20, 2005 11:25 AM

My friend Mary was an alcoholic. She told me that she hasn't taken a sip of alcohol for a year. On December 9th, she had her liver enzymes tested. The GGT enzyme was out of range.

It showed up as "165 H." A followup test on December sixteenth showed that the GGT enzyme was still out of range at "118 H."

On both tests, all the other parameters (AST, ALT, LDH, etc) are showing up normal. I showed a doctor the test results and he said that this meant in his opinion that she was drinking again.

However, after a bit of googling I found that there are many other things that can elevate liver enzymes.

Is Mary lying to me? Are there other things that would specifically elevate GGT or do these test results indicate that she is probably drinking again?

posted by skjønn to science & nature (20 comments total)

It might be time for Occam's Razor. Which is more likely-- the various other things that can elevate GGT or that Mary is drinking?
posted by Faint of Butt at 11:37 AM on December 20, 2005

I am not a doctor, nor do I play one on TV, but I do have a couple of recovering alcoholics in my life (sister and brother-in-law). It seems to me that there should be some other clear indicators other than elevated liver enzymes if, in fact, Mary is drinking again. The opinion of a single physician should not trump your own gut feelings about your friend. Do you think she's drinking again?
posted by JeffK at 11:42 AM on December 20, 2005

Not a doctor so I'm just speculating here, but could the fact that it is just the GGT and not the other enzymes that guided the doctor to the conclusion?

Did the doctor have prior knowledge of her history?

I had elevated liver enzymes on a test once, turned out to be my herbal dietary supplement. I don't take them any more, I don't test abnormal any more either.
posted by Pollomacho at 11:50 AM on December 20, 2005

It seems very likely to me that she's drinking again. Other things can raise liver enzymes but I think Faint nailed it. What's more likely?

Alcohol use is THE classic thing that raises liver enzyme levels -- the liver has to get the alcohol out of your system so it cranks up production of metabolizing enzymes. More enzymes mean everything else gets metabolized out of your system faster too. So in pharmacy school they taught us that if a normal dose of a drug just doesn't seem to be working for some reason, one thing to look for is potential alcholism. Alcoholics frequently need a higher dose than average to get the same effect for many drugs.

Having said that tho, is she taking St. John's Wort? That's one very common otc herbal that is supposed to raise liver enzymes though I can't remember which ones off the top of my head.
posted by selfmedicating at 11:51 AM on December 20, 2005

One of the links seemed to also insinuate that elevated GGT can also be hereditary. It seemed like this was also in conjunction with high cholesterol numbers etc.
I would be apprehensive over believing a doctor who is only looking at the test results and knows nothing of her as a person.
I hope for Mary that there is a reasonable, non-drinking explanation for this elevation and that she can continue on a positive path
posted by TheLibrarian at 12:15 PM on December 20, 2005

An elevated GGT by itself is insufficient to make a diagnosis of alcohol abuse.

A twofold elevation in GGT in combination with an AST:ALT ratio of 2:1 strongly suggests alcohol abuse.
posted by TimeFactor at 12:16 PM on December 20, 2005

IANAD, BTW, JSGOTI.
posted by TimeFactor at 12:18 PM on December 20, 2005

Is it even possible to say that your friend Mary WAS an alcoholic? I thought that the standard wisdom was that you are ALWAYS an alcoholic whether you are drinking or not.
posted by spicynuts at 12:31 PM on December 20, 2005

GGT is actually a pretty sensitive marker for recent alcohol ingestion, however it's specificity to alcohol ingestion alone isn't that great.

But in the setting of otherwise normal liver enzymes (especially a normal alkaline phosphatase), a known history of alcohol abuse, and no alternative explanation (like new meds or other drugs), I'd say it's quite concerning for recent alcohol ingestion even though you can't hang your hat on any one test.
posted by drpynchon at 12:48 PM on December 20, 2005

And by the way, the business about AST/ALT ratios and such noted above is not relevant to your question. While an elevated AST/ALT ratio >2 does also suggest possible alcohol abuse, usually that's in the setting of an elevation in all three of the enzymes, and reflects the possibility of alcoholic hepatitis. Which was not what you were asking.

Interpreting these tests can be rather tricky. See here for a more accurate brief summary.

"In a patient who is known to abuse alcohol; if the AST and ALT are normal then the GGT may provide an indicator of recent alcohol intake."
posted by drpynchon at 1:16 PM on December 20, 2005

Look at her MCV.
posted by docpops at 1:26 PM on December 20, 2005

Oh, and also, this thread can not possibly result in a conclusion that serves any useful purpose as far as making a determination of alcohol use.

Don't forget acetominophen can elevate GGT. So can being overweight.
posted by docpops at 1:28 PM on December 20, 2005

Just curious here, and a little confused. Your friend tells you she's no longer drinking alcohol; you now believe this may be false. She then gets her liver checked, and shares her results with you. Clearly she has a doctor, and you're not it, so I don't know why she would give you the results, especially if they might have indicated drinking. But she did, and then you gave her results to another doctor, who also thinks she's been drinking, based on the results.

I guess my question -- and I acknowledge that it may very well be none of my or MeFi's business -- is why your friend would give you her results. Is it some sort of odd, medically-informed cry for help? Was it just an FYI? Or maybe she's just concerned and didn't know who else to go to -- but, again, I don't know why she didn't talk to the doc who did the tests.

Anyway, I think it might help us help you -- and maybe you help yourself -- to think about why Mary let you in on her tests.
posted by SuperNova at 2:42 PM on December 20, 2005

i know there's already a best answer marked, but i just wanted to throw my weight behind the above six comments. totally. all of them are best answers, and i'm in full agreement.
posted by herrdoktor at 3:24 PM on December 20, 2005

I'm a bit conflicted, the last time I had my liver checked my Doc advised that I should not drink for 24 hours prior to his taking blood or the test would be inconclusive, which it was.

Perhaps my Doc was FOS.
posted by snsranch at 4:09 PM on December 20, 2005

This is nutty. A lot of other things can elevate GGT, including transient bile obstruction (gallstone), various cancers, medications and what not. Trying to make a diagnosis on the basis of a single elevated parameter is not appropriate.

Why the would you take the lab test at face value and not the statement that she's not drinking? Why, for that matter, would you post someone's medical information to the internet without permission?

Lab tests are obtained for physicians to interpret in the context of a history, physical exam, and clinical picture. They are not obtained for any other purpose, including the purpose for which you're trying to use them here. I strongly suggest you form NO CONCLUSION based on these laboratory values, and promptly FORGET ABOUT THEM.
posted by ikkyu2 at 4:48 PM on December 20, 2005

Thanks everyone.

ikkyu2 and everyone who is curious about the situation- perhaps "friend" isnt the best word. Without going into detail of the nature of our relationship, let me assure you that I have every right to view her lab results and nothing improper is going on.

The main concern here is the science and whether elevated GGT means alcohol intake in this case.

For the record she is-
1)not overweight or obese
2)not on new medications, though I'll be double checking that.
posted by skjønn at 5:20 PM on December 20, 2005

You have every right to view her medical information? Does that make you a nurse or other non-doctor that works in the doctor's office she is visiting? If so, why are you sharing this information with the internet?
posted by chiababe at 5:32 PM on December 20, 2005

Please just assume Mary is hypothetical if you need to. Yes, I have every right to view it chiababe, no I am not a healthcare professional in any sense of the word. And Mary is fully aware that I am looking into her tests results and what they may mean. Also, I'm not interested in further conjecture/discussion on the nature of our relationship.
posted by skjønn at 5:44 PM on December 20, 2005

Without going into detail of the nature of our relationship, let me assure you that I have every right to view her lab results and nothing improper is going on.

That's fine. Doesn't change what I wrote, though - a single elevated parameter is meaningless. Bear in mind that the ranges are ninety-fifth percentile ranges. That means that by definition, 1 in 20 tests performed on healthy normals will be "out of range." That's one reason of many that isolated elevations of a lab test aren't meaningful outside of a clinical history; in my clinical experience, GGT elevation is one of the least specific tests out there.
posted by ikkyu2 at 5:50 PM on December 20, 2005